Epidemiology and outcome of postural headache management in spontaneous intracranial hypotension

Background and objectives: Spontaneous intracranial hypotension is a postur al headache syndrome unrelated to dural puncture. Due to the apparent failu re of epidural blood patch to relieve headache in spontaneous intracranial hypotension, we investigated the epidemiologic features and treatment outco mes of this condition. Methods: The clinical findings and management of 22 cases (21 published + 1 reported) of spontaneous intracranial hypotension were analyzed retrospect ively. The study population was stratified by age and sex; continuous varia bles were compared for differences by t-tests; categorical variables were c ompared by Fisher exact tests. Significant differences were identified by P values of .05 or less. Results: The mean age of the study population was 43 +/- 16 years, with a f emale:male ratio of 3.4:1.0. Females with spontaneous intracranial hypotens ion were younger (P =.050) than males, Men presented with tinnitus (P =.021 ) and visual field defects (P =.009) more often than women. Meningeal enhan cement on contrast magnetic resonance imaging was the most consistent radio graphic finding. Radionuclide cisternography showed thoracolumbar dural lea ks in 7 of 9 patients. Cerebrospinal fluid opening pressure was low in all patients (33.13 +/- 31.02 mm H2O). Epidural blood patch was performed in 8 patients, repeated in 3 patients, failed in 3 patients, and offered only tr ansient improvement in 5 patients. Conclusions: Spontaneous intracranial hypotension was more common in women than men, was not uniformly responsive to epidural blood patch, and had sig nificant comorbidities. The management of postural headache in spontaneous intracranial hypotension by other techniques to restore cerebrospinal fluid dynamics and prevent its leakage should be investigated.